Dental caries, a preventable condition, remain an important global public health problem. The use of fluorides for population-based prevention of dental caries has been officially acknowledged by the World Health Organisation (WHO) since the late 1960s (Petersen and Ogawa, 2016). The goals of community-based public health programmes are generally to provide regular, low-level exposure to fluoride in the community through appropriate means such as fluoridated water, salt, milk and fluoride toothpaste.
Considering the narrow ‘dose-gap’ between the benefit of caries reduction and the risk of dental fluorosis, public health authorities should monitor total fluoride exposure of the population before and after introducing any fluoridation or supplementation programme for prevention of dental caries.
Direct assessment of total fluoride exposure in a population can be difficult and expensive. Identification of practical and accurate biomarkers for fluoride exposure has therefore gained considerable attention over the past several decades.
Daily urinary fluoride excretion has been suggested as a suitable biomarker for predicting fluoride intake for groups of people. In its recent publication, WHO has endorsed the use of daily (24h) urinary fluoride excretion for monitoring fluoride exposure in community prevention programmes for oral health. Due to practical difficulties in collecting 24h urine samples from children, spot urine samples and nail clippings have been used (Rugg-Gunn et al., 2011; Pessan and Buzalaf, 2011) as simpler alternatives. However, a clearer perspective is needed to better understand the association between fluoride intake and either biomarker (spot urine and nail clippings) and map situations including populations, settings, and methods used in which they are strongly associated with intake.

The aim of this scoping review is to map the current literature/evidence on the use of spot urine samples and nail clippings for monitoring fluoride exposure at a community level. The specific objective of this review is to identify the nature and extent of the available evidence on how these two biomarkers are used to measure fluoride intake according to the study population, setting, type of study design, methodology and analytical approach. The evidence will help to clarify the extent of research that is available and identify gaps in knowledge which will guide future research and inform practice.

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